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Changes to Ohio’s Do Not Resuscitate (DNR) Laws
Types of DNRs Available in Ohio
Under Ohio law there are currently two different types of Do-Not-Resuscitate Orders (DNR) a person, in consultation with a physician, Advanced Practice Registered Nurse (APRN), or physician assistant (PA), can elect: a DNR-Comfort Care (DNRCC) and a DNR Comfort Care-Arrest (DNRCC-Arrest). The difference between the two types of DNRs is the standard protocol for treatment when the DNR becomes active. For an individual with a DNRCC order, the DNR protocol activates when the DNR order is issued. For an individual with a DNRCC-Arrest order, the DNR protocol becomes active when the patient experiences either a cardiac arrest or respiratory arrest.
What Medical Professionals Will Do or Not Do When There is an Active DNR
When a patient has an active DNR, whether it be an DNRCC or DNRCC-Arrest, medical professionals treating the patient will still preform some medical procedures and treatments. These medical procedures and treatments include:
- conduct an initial assessment;
- perform basic medical care;
- clear airway of obstruction or suction;
- if necessary, for comfort or to relieve distress, they may administer oxygen; CPAP or BiPAP;
- if necessary, they may obtain IV access for hydration or pain medication to relieve discomfort; but not to prolong death; and
- if possible; they may contact other appropriate health care providers; such as hospice or home health.
When a patient has an active DNR, medical professionals treating the patient will not initiate CPR. CPR includes seven different procedures/treatments. They are:
- administration of chest compressions;
- insertion of an artificial airway;
- administration of resuscitation drugs;
- defibrillation or cardioversion;
- provision of respiratory assistance;
- initiation of resuscitative intravenous line; and
- initiation of cardiac monitoring.
Please note that if a DNRCC-Arrest is put into effect, until the patient has either a cardiac arrest or respiratory arrest and the DNRCC-Arrest becomes active, the patient will receive full medical treatment.
How to Execute a Valid DNR
Under the most recent update of Ohio law regarding DNRs, the DNR form went from three pages down to just one. On this single page the patient (or an authorized representative) will have to check a box to indicate what type of DNR they wish to have; either a DNRCC or DNRCC-Arrest. Under the updated Ohio law, a patient may have a physician, APRN or PA sign the DNR form in order for it to be valid; the patient’s signature is not required. However, it is strongly suggested that the DNR be signed by a physician. While the Ohio DNR law has been updated to allow APRN and PAs to sign the DNR form, under Ohio EMT laws, EMTs are only allowed to honor either type of DNR form when it has been signed by a physician. Also, no additional writing or instructions can be on the form. If there is additional writing on the form, then the form is void. Having a valid DNR also allows the patient to order a medical alert bracelet, necklace or wallet card which will notify EMT or other medical professionals the patient has a valid DNR in place.
Many patients may believe that a living will is equivalent to a valid DNR. However, a living will can only act as a DNR if specific instructions are added in the box for additional instructions found in the Ohio Living Will. Even if the additional instructions are added, the living will is a conditional document requiring certifications from two physicians in order to become “operative.” With respect to EMTs or, perhaps emergency rooms, the living will is virtually ineffective as a DNR.
Best Practice
If a person wishes to have a valid DNR in place, the best practice would be to consult with one’s attorney and physician. If a DNR still is desired, (i) choose the correct DNR form, (ii) have the physician fill out and sign the appropriate DNR form, and (iii) obtain the medical alert bracelet, necklace or wallet card. This best assures that if the patient requires EMTs to called to their home, the EMTs will honor the DNR.
Should you have any questions regarding DNRs, please contact Mr. Weaver.
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Disclaimers:
The article in this publication has been prepared by Eastman & Smith Ltd. for informational purposes only and should not be considered legal advice. This information is not intended to create, and receipt of it does not constitute, an attorney/client relationship.